INTRODUCTION:
Drug utilization studies aim to evaluate factors related to the prescribing ,dispensing , administering and taking of medication and its associated events either beneficial or adverse1. Irrational drug use is a common problem worldwide. The constantly increasing number of medicine and treatment options serve to increase the irrational medicine treatment encounters that ultimately lead to poor patient outcome and significant wastage of money and resources. The impact of inappropriate medicine use on the healthcare system is reduction of quality of medicine therapy leading to increased risk of unwanted effects such as adverse medicine reaction2.
Drug Utilization studies help to find out description of drug use pattern; early signals of irrational use of drugs; interventions to improve drug use. It is quality control cycle; by which continuous quality improvement of drug done.3 Especially in a developing country like India, irrational prescribing is a common finding. Various countries have made drug utilization review boards to provide information on drug utilization data at national level1.
Data of antibiotic utilization for treatment of infectious diseases are needed in developing antibiotic use policy, The increasing prevalence of antibiotic- resistant bacteria poses a major threat to the health of patient.4 The relationship between emergence of resistance and antibiotic use and misuse was well recognized. It is evident that antibiotic affects not only the microorganism and the individual patients, but also the population as a whole5.
Urinary tract infections (UTI’s) are the most common bacterial infection. There are an estimated 150 million urinary tract infections per annum worldwide. UTIs are most common bacterial infections in women than men in India and frequent reason to prescribe antibiotics in general practice6. Therefore it account for significant morbidity and health care cost. Escherichia coli is the most common urinary tract pathogen, uncomplicated UTIs are extremely common accounting for 50 % of women experiencing at least one symptomatic UTI in their lifetimes7.
The World Health Organization (WHO) collaborating Center for Drug statistic and Methodology recommends using of defined daily doses (DDD) per 1000 patient days to quantify antibiotic use. The DDD is a technical unit of measurement and corresponds to the assumed average maintenance dose per day, for the main indication of the drug in adults.DDD methodology can be used to compare drug consumption among institutions, regions and countries8. In 1996, WHO recognized the need to develop use of ATC/DDD system as an international standard for drug utilization studies. The purpose of the ATC/DDD system is to serve as a tool for drug utilization research in order to improve quality of a drug use9.Essential medicines list, present a list of minimum medicine needs for a basic health-care system, listing the most efficacious, safe and cost-effective medicines for priority conditions10.
DU90% method has shown to be a valuable tool for assessing the overall quality in prescribing and to form the basis for more specific analysis using prescription, patient specific quality indicators. This research aims to find out DU90% of UTIs drug and promote rational use of antibiotics used in UTIs. When large number of antibiotics are available it will enhances the inappropriate antibiotic choice. High quality prescribing is therefore associated with the use of a relatively limited number of antibiotics. This study describes drug utilization for treatment of UTIs in tertiary care hospital, Nasik.
MATERIALS AND METHODS: –
Approval from Institutional Ethics Committee was obtained. Patients fulfilling inclusion and exclusion criteria will be enrolled in study by taking their Informed consent. A prospective cross-sectional study will be undertaken for 12 weeks. Data on the prescription of antibiotics were retrieved from medical record of patient with urinary tract infections at outpatient department and in patient department. The antibiotics were recorded by trade name, and the information obtained included antibiotic names, strength and quality prescribed. Each antibiotic was then given its chemical name and a code according to the ATC classification. The first level is the anatomical group, second is the therapeutic group, the third is a therapeutic subgroup, the fourth the chemical form and the fifth is a chemical subgroup.
Antibiotic consumption was determined in terms of defined daily dose DDD /1000/day for all antibiotics. DDD was calculated according to the 2010 ATC classification (as given in Table no.1). Antibiotics were ranked by percentage of DDD/1000/day and antibiotics that accounted for 90% (DU90%) were determined (as mentioned in Figure no.1).
The DDD/1000/day was calculated as follows,
Total no. dosage unit prescribed X strength of each dose X 1000Unit
DDD/1000/DAY =
DDD (ATC) X Duration of study in Weeks X Total sample Size.
Prescribing and patient care indicators were calculated as follows,
Core indicator-
(A) Prescribing indicators:
1) Average number of drugs per encounter was calculated by dividing the total number of different drug products prescribed by the number of encounter surveyed .
2) Percentage of drugs prescribed from essential drug list was determined by dividing the number of products prescribed from Essential drug list of the hospital by the total number of drugs prescribed, multiplied by 100.
(B) Patient Care Indicators :
1) Average consultation time was determined by dividing the total time for a series of consultations, by the actual number of consultations.
2) Average dispensing time was calculated by dividing the total time for dispensing drugs to a series of patients, by the number of encounters.
3) Percentage of drugs actually dispensed was worked out by dividing the number of drugs actually dispensed at the health facility by the total number of drugs prescribed, multiplied by 100.
RESULT AND DISCUSSION:–
100 patients with urinary tract infections were enrolled from OPD of tertiary care hospital, Nasik. Total quantity of antibiotic used amount to 2.82 DDD/1000/Day. The number of antibiotic agents used was 6 items, derived from 5 classes.
There were 5 agents of antibiotics within DU90% segment included – Norfloxacin, Cifixime, Amoxicillin, Metronidazole, and Ciprofloxacin. Norfloxacin was the most prescribed antibiotic, where one study in Indonesia done in Hospitalized patients with UTIs at 2 hospitals in Yogykarta in 2008 they got third generation cephalosporin as most prescribed antibiotics.
Trimethoprim-Sulfamethoxazole recommended as empirical antibiotic for treating acute uncomplicated urinary tract infection, its use was very low in this study. However, the widespread use of fluoroquinolones for such a common infections raises concern regarding the possibility of development of resistance.
In Patient care indicators Average consultation and Average dispensing time was 5.06 and 4.42 mins. respectively which reflect better patient care.
Figure no. 1 - Use of antibiotics for patients with urinary tract
infections as percentage of DDD/1000/Day and antibiotics agent within DU 90%
segment
|
Sr. No. |
Antibiotic Agent |
ATC code |
Consumption(DDD/1000/day) |
|
1.
2.
3.
4.
5. |
Broad spectrum penicillin Amoxicillin - Third generation cephalosporin Cifixime - Sulfonamide combination Trimethoprim – Sulfomethoxazole - Fluoroquinolones Ciprofloxacin - Norfloxacin - Imidazole derivates Metronidazole - |
J01CA04
JO1DD08
J01EE01
J01MA02 J01MA06
J01XD01
Total |
0.48
0.63
0.17
0.40 0.69
0.45
2.82 |
Table no. 1. Antibiotic utilization for treatment of patients with UTIs according to the ATC
Classification during 2010 expressed as number of DDD/1000/Day
(A) Prescribing indicators-
% of drug prescribed from essential drug list- 62.5%
Average no. of drugs per encounter- 1.54
(B) Patient care indicators-
1. Average consultation time - 5.06 min.
2. Average dispensing time - 4.42 min.
3. % of drug actually dispensed - 67
4. No. of drugs per prescription - 3
Antibiotic are playing important major role in treating infections disease. Proper use of antibiotics is necessary to avoid resistance to antibiotics; which done by method like Drug utilization in which DDD methodology provides tool for quantification of antibiotics use and allow comparison between different region, countries. Limitations of study are low sample size and short duration of time.
CONCLUSION: –
Feedback with DU 90% prescribing profiles may be useful in the implementation of guidelines and in identifying areas to be subject of a deeper review.
This study gives drugs most commonly used in tertiary care hospital for UTIs treatment, within which 62.5% were from essential drug list and Norfloxacin found most commonly used drug.
REFERENCES:-
1. Helena Gama, Drug Utilization Studies, Departmento de Investigacao e desenvolvimento, Bial, Porto, vol.22, 2008.
2. Parvinder Singh and Dr. P. Tiwari , Drug Utilization studies : The need for a common protocol, Express Healthcare Management, March 2005.
3. World Health Organization , WHO collaborating center for Drug utilization Research and Clinical Pharmacological Services , 20 Avenue Appia , 1211 Geneva 27, Switzerland ; 2003.
4. Cosgrove, SE., Kaye, KS., Eliopoulus, GM., et al., 2002, Health and economic outcomes of the emergence of third-generation cephalosporin resistance in Enterobacter species, Archive of Internal Medicine, 162, pp. 185-90.
5. Rubin, MA. and Samore, MH., 2002, Antimicrobial use and resistance, Current Infectious Disease Reports, 4, pp. 491-497.
6. Eva Hummers-Pradier, Ann Marit Ohse et al; Management of urinary tract infections in female general practice patients, Family practice Advance Access, 7 Jan.2005.
7. Paul Irwin, management of uncomplicated urinary tract infections,trends in Urology Gynaecology and Sexual Health,March/April2008.
8. Saepudin, Drug utilization 90% (du90%) profile of antibiotic for treatment of hospitalized patients with urinary tract infections at two hospital in Yogykarta., Department of Pharmacy, Islamic University of Indonesia, Jurnal Ilmiah Farmasi Vol.5 No.1 Tahun 2008.
9. Guideline for ATC classification and DDD assignment 2010,WHO collaborating center for drug statistics methodology, Norwegian Institute of Public Health, Norway.
10. WHO Model list of Essential Medicines,16th List March 2009.
Received on 02.06.2011 Modified on 10.06.2011
Accepted on 23.06.2011 © RJPT All right reserved
Research J. Pharm. and Tech. 4(8): August 2011; Page 1328-1330